The NHS Debate (Merged threads)

[Saintslass]

Grow up.  They've cut £20bn from NHS in "efficiency" savings and haven't increased spending by the amount required to keep up with health inflation.  The Tories have been a disaster for the NHS. No change there then.

No need to be rude.

 

The NHS budget has been protected since 2010.  If the same levels of cuts had been applied to the NHS as have been applied to local government, for example, you would be justified in your statement.  However, efficiency savings are not the same as cuts and never have been.  Efficiency savings are all about making money go further, not taking money away at source.  Efficiency savings within the public sector are a necessity when the public pot isn't full of credit anymore but in fact is full of debt. 

 

It wouldn't surprise me if some of the overspend now being recorded everywhere has politics lurking in there somewhere, given that the overspend has only taken off since the Tories came to power (but no cuts to the NHS have been announced and in fact extra funds have been made available and already swallowed up). 

 

The NHS needs to adapt.  Throwing loads of money at it regardless of how that money is spent or managed is both irresponsible and unsustainable. 

[Alfie Taylor]

Grow up. They've cut £20bn from NHS in "efficiency" savings and haven't increased spending by the amount required to keep up with health inflation. The Tories have been a disaster for the NHS. No change there then.

You seem really irritated by these "efficiency savings" yet you voted for them? Why was that?

[gingerjon]

 the Trust was rated Good with Outstanding Features, which is better than Good

 

No. It was rated Good.

 

It also had areas rated poor and areas (such as A&E) requiring action.

 

Hence "Good".

 

There is no "Good +".

 

But if you want to believe a corporate press release go ahead.

[ckn]

No. It was rated Good.

 

It also had areas rated poor and areas (such as A&E) requiring action.

 

Hence "Good".

 

There is no "Good +".

 

But if you want to believe a corporate press release go ahead.

A clarification: The overall Trust was rated as Good while St Helens Hospital was rated as Outstanding.  When it comes to the way NHS England rates then it's the Trust level that's important as it shows how they manage across the entire Trust estate, the nice new hospital is the star of the Trust though.  The challenges the Trust will have next year will come from the CCGs commissioning services from the hospital who tend to look at "outstanding" grades and think that they've obviously too much money.

[gingerjon]

A clarification: The overall Trust was rated as Good while St Helens Hospital was rated as Outstanding.

 

I think I said that earlier.

 

And if you read the report it's very obvious the Trust (rather smartly) addresses concerns from previous reports as it knows they will be what it goes for first.  So the folk of St Helens and Knowsley can expect improvements in A&E and Maternity ahead of anything else in the next review period.

 

As for the budget.  The report mentions that a lot of staffing is done on agency and bank.  I'm sure there's nothing to worry about there.

[Trojan]

You seem really irritated by these "efficiency savings" yet you voted for them? Why was that?

How do you know how I voted?  How do you know I voted at all?

[ckn]

I think I said that earlier.

 

And if you read the report it's very obvious the Trust (rather smartly) addresses concerns from previous reports as it knows they will be what it goes for first.  So the folk of St Helens and Knowsley can expect improvements in A&E and Maternity ahead of anything else in the next review period.

 

As for the budget.  The report mentions that a lot of staffing is done on agency and bank.  I'm sure there's nothing to worry about there.

St Helens CCG were one of 65 CCGs given fully devolved budgeting power for primary care, i.e. GPs and so on, they're getting no extra budget for it but are getting one hell of a lot more responsibility.  If a Trust within a CCG area goes wrong then the CCG can point to them but if primary care starts to go badly then the CCG gets it in the neck, if I were a Trust director at a place where one of my hospitals had Outstanding grading then I'd be getting written commitments now that my funding wouldn't change next year.

[ckn]

A very interesting change of position on fines incurred by NHS organisations happened today. 

 

Until today, the rules encouraged commissioners, where possible, to reinvest any money raised from such fines “in a way which will help to rectify the performance problem that gave rise to the sanction”.  With retrospective effect to 1st January, the money now goes to fund the overall DoH budget meaning the Exchequer doesn't have to pay as much, any sanctions brought into the commissioners will see the amount of money they get from NHS England reduced and so on up the chain all the way to the Exchequer.

 

Hmmm, I wonder if we'll suddenly see a stricter sanctioning scheme for NHS organisations to meet recoupment targets.  Another stealth cut but that nice Mr Hunt will still insist that he hasn't cut a single thing.

[ckn]

Oh, and this one.  (I've read the original report and the Indy is under-reporting if anything)

[ckn]

The government that has "ring fenced" and "won't cut" the NHS has announced a £170m "efficiency saving" that could see 3000 pharmacies, about 1/4 of the pharmacies in England, close with a disproportionate effect on the small independent pharmacies.  And that's just what Alistair Burt, the health minister, said yesterday to the All Party Pharmacy Group.  Nope, no cuts to the NHS here, just an "efficiency saving", move along, nothing to see.

 

This comes at the time when the government is pushing people to go to pharmacies for minor issues and even allowing pharmacists to access Summary Care Records.

 

Edit:  Daily Mail article on that

[ckn]

The government that has "ring fenced" and "won't cut" the NHS has announced a £170m "efficiency saving" that could see 3000 pharmacies, about 1/4 of the pharmacies in England, close with a disproportionate effect on the small independent pharmacies.  And that's just what Alistair Burt, the health minister, said yesterday to the All Party Pharmacy Group.  Nope, no cuts to the NHS here, just an "efficiency saving", move along, nothing to see.

 

This comes at the time when the government is pushing people to go to pharmacies for minor issues and even allowing pharmacists to access Summary Care Records.

 

Edit:  Daily Mail article on that

I mentioned this at a strategy session this lunchtime and one guy said "so, we know that independent pharmacies typically employ an average of eight pharmacists and pharmacy technicians, never mind the non-pharmacy trained staff doing admin and shop duties, that's approximately 20,000-24,000 trained and qualified professionals out of a job plus the other employees all with nowhere to go for a job".

[gingerjon]

I mentioned this at a strategy session this lunchtime and one guy said "so, we know that independent pharmacies typically employ an average of eight pharmacists and pharmacy technicians, never mind the non-pharmacy trained staff doing admin and shop duties, that's approximately 20,000-24,000 trained and qualified professionals out of a job plus the other employees all with nowhere to go for a job".

 

I am actually speechless.  Without speech.  Struck dumb.

 

We've been part of the drive to get people to go to their chemist when they have symptoms which are annoying but maybe they've already been to their GP or maybe it's just better to see if there's an over the counter medicine which can control symptoms.  These people need to talk to pharmacists.  You can't just walk in and grab something and hope.  You also, for it to work, need a pharmacist that is approachable and that has time.

[ckn]

I am actually speechless.  Without speech.  Struck dumb.

 

We've been part of the drive to get people to go to their chemist when they have symptoms which are annoying but maybe they've already been to their GP or maybe it's just better to see if there's an over the counter medicine which can control symptoms.  These people need to talk to pharmacists.  You can't just walk in and grab something and hope.  You also, for it to work, need a pharmacist that is approachable and that has time.

Another example of the finance folk in the Treasury knowing the cost of everything but the value of nothing.

[gingerjon]

Another example of the finance folk in the Treasury knowing the cost of everything but the value of nothing.

 

I am still reeling.

[Griff9of13]

The government that has "ring fenced" and "won't cut" the NHS has announced a £170m "efficiency saving" that could see 3000 pharmacies, about 1/4 of the pharmacies in England, close with a disproportionate effect on the small independent pharmacies.  And that's just what Alistair Burt, the health minister, said yesterday to the All Party Pharmacy Group.  Nope, no cuts to the NHS here, just an "efficiency saving", move along, nothing to see.

 

This comes at the time when the government is pushing people to go to pharmacies for minor issues and even allowing pharmacists to access Summary Care Records.

 

Edit:  Daily Mail article on that

 

Can anyone point out where this was made clear in the 2015 Tory election manifesto?

[ckn]

Can anyone point out where this was made clear in the 2015 Tory election manifesto?

They did actually, they agreed to fund the NHS Five Year Forward View for the NHS in England.  The 5YFV showed a likely net deficit of £30bn p/y for the NHS by 2020/21, the plan was agreed that the NHS would take the hit of providing "efficiency savings", or cuts as they've been known for generations, of £22bn if the government made up the residual £8bn in new money.  This £170m is part of those "efficiency savings".

 

So, from a manifesto perspective, they promised £8bn in new money as part of that 5YFV and didn't feel the need to expand that that also committed them to cut the NHS by £22bn.  Labour neither could nor did challenge the Tories on this because all they offered was £2bn of that £8bn courtesy of Balls and Burnham.  The Lib Dems joined in with the Tories in agreeing the 5YFV plan.

 

It's one of these things that years down the line people will say "but no-one told us that!" and you get the war-weary lot saying "we tried but no-one would listen".

[Saintslass]

The government that has "ring fenced" and "won't cut" the NHS has announced a £170m "efficiency saving" that could see 3000 pharmacies, about 1/4 of the pharmacies in England, close with a disproportionate effect on the small independent pharmacies.  And that's just what Alistair Burt, the health minister, said yesterday to the All Party Pharmacy Group.  Nope, no cuts to the NHS here, just an "efficiency saving", move along, nothing to see.

 

This comes at the time when the government is pushing people to go to pharmacies for minor issues and even allowing pharmacists to access Summary Care Records.

 

Edit:  Daily Mail article on that

I'm amused that you have chosen to link to the Daily Mail!  I can't say I've seen this reported in the Guardian, a paper that jumps on everything and anything the government does or says (and I read the Guardian online every day, just as I read the Telegraph - when it allows me - and the BBC website every day, although I may have missed it). 

 

I'd like to know what is actually proposed.  I couldn't make sense of that in the link.  I picked up that pharmacies would be protected where to close them would leave a community without cover.  I picked up that pharmacy businesses tend to 'cluster' (and I can confirm that - I have at least six within a ten minute walk from where I live).  I picked up that the NHS want to encourage more people to complete prescriptions online in order to reduce the need for built premises.  I picked up that the NHS wants more pharmacies situated within GP surgeries (mine has one).  I picked up that the government is encouraging people to ask pharmacists questions about minor ailments rather than bother GPs/A&E departments (which maybe should start turning people away if they have minor ailments!).

 

Can six pharmacies within a ten minute walk of me be justified financially?  I've often wondered how they all keep going.  There are two on opposite sides of the same road within two minutes' walk from my front door.  There are people living in my neighbourhood but there are also lots of non-residential premises so it isn't exactly cramped.  Would it not be better to have, say, two bigger pharmacies employing more staff but without the overheads of six buildings? 

[ckn]

I'm amused that you have chosen to link to the Daily Mail!  I can't say I've seen this reported in the Guardian, a paper that jumps on everything and anything the government does or says (and I read the Guardian online every day, just as I read the Telegraph - when it allows me - and the BBC website every day, although I may have missed it). 

 

I'd like to know what is actually proposed.  I couldn't make sense of that in the link.  I picked up that pharmacies would be protected where to close them would leave a community without cover.  I picked up that pharmacy businesses tend to 'cluster' (and I can confirm that - I have at least six within a ten minute walk from where I live).  I picked up that the NHS want to encourage more people to complete prescriptions online in order to reduce the need for built premises.  I picked up that the NHS wants more pharmacies situated within GP surgeries (mine has one).  I picked up that the government is encouraging people to ask pharmacists questions about minor ailments rather than bother GPs/A&E departments (which maybe should start turning people away if they have minor ailments!).

 

Can six pharmacies within a ten minute walk of me be justified financially?  I've often wondered how they all keep going.  There are two on opposite sides of the same road within two minutes' walk from my front door.  There are people living in my neighbourhood but there are also lots of non-residential premises so it isn't exactly cramped.  Would it not be better to have, say, two bigger pharmacies employing more staff but without the overheads of six buildings? 

In summary, to save you time, independent pharmacies tend to have fewer non-prescription services, these will be disproportionately affected leaving the big chains and supermarkets to rule the market PLUS get the additional footfall that used to go to the independents.  20,000+ pharmacists and pharmacy technicians plus additional staff will lose their jobs, big businesses will make more income AND have a genuine excuse for refusing to provide extended free advice because they no longer get paid enough.  Wins all around, if you're in the bigger pharmacy providers, that is.

 

Extensive and repeated studies of pharmacy services show that ill people trust independents far more than chains to provide unbiased opinions and that ill people would rather wait days for a GP appointment than rely on big chains to offer impartial advice.  Also, medicines management analysis shows that independent pharmacists are far more likely to offer generic medicines in all categories from unrestricted, pharmacy only and prescription only drugs.

 

In the great scheme of things, £170m isn't that much when you take into account the social cost of the cuts on both patients and the staff involved.  It also makes a massive mockery of the scheme to make pharmacists busier by pushing more and more patients onto them to treat.  Just as with the junior doctors, this is the government wanting far more for far less and really not giving a damn who they affect.

[ckn]

Also, forgot to put this but it was meant to go there, the chains will make their money by only selling generics when specifically asked for.  Want ibuprofen?  They'll sell you Nurofen at 10 times the price of generic, but identical, ibuprofen.  Same with all the other drugs.  They'll not lose out in this.

[Saintslass]

Also, forgot to put this but it was meant to go there, the chains will make their money by only selling generics when specifically asked for.  Want ibuprofen?  They'll sell you Nurofen at 10 times the price of generic, but identical, ibuprofen.  Same with all the other drugs.  They'll not lose out in this.

I call BS on this, if Boots are anything to go by.  Boots sell their generic ibuprofen much cheaper than they sell Nurofen.  Ditto for every other product for which Boots produce a generic item.

[Alfie Taylor]

Our town has 7 pharmacies. 2 on the outskirts and 5 in the town centre, an equilateral triangle with sides 250m would cover them all.

1 in the health centre.

1 large independent

1 small independent that does deliveries

1 Boots

1 Lloyds

All of these will receive NHS funds? So are not technically independent?

The health centre and Boots are generally the busiest, though I've never been in the Lloyds. The Boots appears to be gossip HQ.

The large independent (which I use) with its homely, salt of the earth, non corporate, we're here to help attitude, has a defect with its pricing machine for non prescription goods that sees it adding a premium over and above what I can pay in other shops in town.

What diagnostic training do the pharmacists have? Is it a full medical type or a science degree with some extra pharmaceutical training?

What diagnostic training do their technicians have?

Do they have to abide with doctor/patient confidentiality rules?

Will the £170m stay within the NHS or will it go back to the Treasury? That's the actual issue here, not the doomsday scenario of people queueing out of the doors at Boots to have their clearly broken arm examined by a 17 year old trainee, who's also on the make up counter.

"efficiency savings" aren't cuts, unless the money saved is removed from the system completely. Is the £20bn achievable? Who knows, I imagine in an organisation as massive and complicated as the NHS then it's probably worth having a look.

Though in my experience (efficiency savings every year in targets) the savings become more and more time based, so harder to put a monetary value on, but we somehow do.

Apparently hand transplants are now going to be available on the NHS, that'll be cheap.

[Alfie Taylor]

I call BS on this, if Boots are anything to go by. Boots sell their generic ibuprofen much cheaper than they sell Nurofen. Ditto for every other product for which Boots produce a generic item.

Ah, if you're prescribed ibuprofen, they don't point to the shelves and tell you to get the cheapo version.

[gingerjon]

Our town has 7 pharmacies. 2 on the outskirts and 5 in the town centre, an equilateral triangle with sides 250m would cover them all.

1 in the health centre.

1 large independent

1 small independent that does deliveries

1 Boots

1 Lloyds

All of these will receive NHS funds? So are not technically independent?

The health centre and Boots are generally the busiest, though I've never been in the Lloyds. The Boots appears to be gossip HQ.

The large independent (which I use) with its homely, salt of the earth, non corporate, we're here to help attitude, has a defect with its pricing machine for non prescription goods that sees it adding a premium over and above what I can pay in other shops in town.

What diagnostic training do the pharmacists have? Is it a full medical type or a science degree with some extra pharmaceutical training?

What diagnostic training do their technicians have?

Do they have to abide with doctor/patient confidentiality rules?

Will the £170m stay within the NHS or will it go back to the Treasury? That's the actual issue here, not the doomsday scenario of people queueing out of the doors at Boots to have their clearly broken arm examined by a 17 year old trainee, who's also on the make up counter.

"efficiency savings" aren't cuts, unless the money saved is removed from the system completely. Is the £20bn achievable? Who knows, I imagine in an organisation as massive and complicated as the NHS then it's probably worth having a look.

Though in my experience (efficiency savings every year in targets) the savings become more and more time based, so harder to put a monetary value on, but we somehow do.

Apparently hand transplants are now going to be available on the NHS, that'll be cheap.

 

I do like how the most ignorant shout the loudest.

 

*sets to ignore*

[Saintslass]

Ah, if you're prescribed ibuprofen, they don't point to the shelves and tell you to get the cheapo version.

I didn't realise anyone was prescribed ibuprofen!

[Bob8]

I do like how the most ignorant shout the loudest.

 

*sets to ignore*

Ironically, I had already done that and only say the post as you replied to it.

 

Funny, he has not posted on rugby league ever.